Role of doppler ultrasound in evaluation of arteriovenous hemodialysis fistula and maturation, complications of hemodialysis vascular access

Abstract

Introduction: Arteriovenous fistula (AVF) is the preferred vascular access for hemodialysis due to its superior long-term patency and lower complication rates. However, primary failure and delayed maturation remain significant challenges. Doppler ultrasound offers a non-invasive method for evaluating vascular anatomy and hemodynamics, potentially improving AVF outcomes. This study aimed to assess the utility of Doppler ultrasound in evaluating AVF maturation and predicting complications in hemodialysis patients.

Methods: This prospective study included 109 patients undergoing AVF creation for hemodialysis access. Preoperative Doppler ultrasound was performed to assess cephalic vein and radial artery diameters and flow parameters. Postoperative evaluations were conducted on day 1, day 7, and at 4 weeks to monitor vein diameter, flow rates, and complications. Patients were followed until successful cannulation or determination of primary failure.

Results: The cohort comprised 57.8% males with a mean age of 52.4 years. Diabetes mellitus (54.1%) and hypertension (52.3%) were the predominant comorbidities. Preoperative mean cephalic vein diameter was 1.98±0.58 mm, increasing to 9.07±0.75 mm at 4 weeks post- operation. Fistula flow rates progressively increased from 261.1±106.3 ml/min on day 1 to 689.7±138.09 ml/min at 4 weeks. By 4 weeks, 51.4% of AVFs achieved adequate maturation. Primary failure occurred in 24.8% of cases and was significantly associated with diabetes, hypertension, smaller preoperative vessel diameters, and lower flow rates at 4 weeks (p<0.001). The mean time to maturation was 38.03±6.8 days, with first successful cannulation at 50.4±8.1 days. Thrombosis (9.17%), infection (5.5%), and stenosis (1.83%) were the most common complications, all being significantly more prevalent in the primary failure group.

Conclusion: Doppler ultrasound parameters, particularly preoperative vessel diameters and 4- week flow rates, are significant predictors of AVF maturation and primary failure. Routine ultrasound evaluation facilitates optimal vascular access planning, timely detection of complications, and improved AVF outcomes in hemodialysis patients.